APS Health Insurance Coverage for Opiate Addiction Treatment

Addictions Content Team Info icon
Calendar icon Last Updated: 09/15/2021

Reading Time: 3 minutes

America is facing an opiate epidemic and it isn’t progressing just because of a substantial increase in the number of heroin users. No. It’s the product of an increase in prescription opiate abuse. There is, however, a clear relationship between prescription opiate abuse and heroin use; one often leads to the other.

People in opiate addiction treatment, who responded to a 2014 survey, reported that they chose to switch to heroin because of the high cost of prescription opiates and the difficulty of obtaining them. Many people face these challenges and turn to heroin use. You know that you don’t want to end up another statistic; you need to break your addiction to opiates and professional substance abuse treatment is the most successful route possible.

But, can you depend upon your APS health insurance to cover the costs of your treatment? In this post, some common questions will be answered and that should give you a general idea of what you can expect. But, each policy offers different coverage; therefore, you will want to get some more individualized information.

Has the Affordable Care Act (Obamacare) Had an Effect on APS Health Insurance Coverage of Opiate Addiction Treatment?

When the Affordable Care Act (Obamacare) passed in 2014 it required small group and individual plans to provide what it called ten essential benefits, services or items that must be made equally available. One of the essential benefits was substance abuse treatment. Now, it must be covered by insurance in a way equal to that which is provided for other medical conditions.

Your APS coverage must:

  • Be available for substance abuse treatment
  • Be available even in instances where the addiction is a pre-existing condition
  • Not place lifetime or yearly dollar limits on coverage of substance abuse treatment

Does APS Health Insurance Cover Treatment for Opiate Addiction?

Because of the changes caused by the Affordable Care Act, you can completely count on APS to provide treatment for opiate addiction. But, that doesn’t mean that all policies will provide the same level of coverage. Opiate addiction is quite difficult to treat and often requires inpatient care and medication-assisted treatment, like methadone, but your plan may only cover that which is strictly deemed medically necessary. It is important that you research your specific plan and policy so that you understand the options available to you.

How Much of the Cost of Treatment Will APS Health Insurance Cover?

You need to also research your plan to prepare for potential out-of-pocket expenses. As different levels of treatment are covered based on the specific policy, you can count on some level of coverage, but you need to know exactly what it is. Expect the degree of coverage to match what you have experienced in financing other medical and surgical undertakings. Be prepared for copays, deductibles, and maximum per-day costs.

Is It Acceptable for Me to Pay Above What APS Health Insurance Covers?

You will either receive full or partial coverage of your treatment, but it is extremely unlikely that APS health insurance will cover all of the related expenses 100 percent. You will still have to provide copays and meet deductibles before coverage kicks in.

When you have researched your treatment options and narrowed your choices, contact the finance department of every program you are considering and determine what your policy will cover and how much you will have to contribute in order to receive the level of care your opiate addiction requires.

To maximize coverage, remain in-network. These providers have a contract with APS and that keeps cost related to treatment lower than they would be otherwise. If you choose to go out-of-network, to extend your tie in rehab beyond what is covered, or seek out luxury treatment, you are welcome to pay the difference without it affecting your insurance.

You need to know what you can expect from your specific policy and we can help. Find addiction treatment in your state today.